Understanding resilience in medical interns through ecological momentary assessments, predictive modelling, and topic...

Healthcare systems worldwide, including in Switzerland, face critical challenges from staff shortages, threatening their sustainability and quality of care. Medical interns transitioning into professional roles often experience heightened stress and burnout, which are key contributors to early career attrition. It is crucial to identify specific factors that foster resilience and to understand interns' perspectives, attitudes, and coping strategies in this period.

In a longitudinal study, we followed 105 Swiss medical students (72% female, 21-35 years) from the start of their first internships with baseline questionnaires and follow-ups at 3, 6, and 12 months. Momentary stress and affect were assessed in three 2-week ecological momentary assessment bursts. We examined skills improvement, burnout, changes in well-being, and career motivation, using multilevel and (regularised) regression to identify baseline and intra-internship predictors. Topic modelling was used to explore student recommendations on reducing stress and improving resilience.

Analyses show three overarching predictive factors: work dissatisfaction, social and team factors, and degree of practical involvement. In turn, lower burnout and higher skills improvement relate to motivation to continue in medicine. Students report higher negative affect while on duty, which is mediated by feeling less comfortable in present company. Most suggest organisational improvements and a healthy work-life balance to deal with internship stress.

Using quantitative and qualitative analyses of data collected on different time scales, we provide an extensive account of medical students' internship experiences. Our findings inform medical education and contribute to improving the well-being of future doctors, ultimately benefitting patients.